The association of circadian parameters and the clustering of fatigue, depression, and sleep problems in breast cancer survivors: a latent class analysis

• Published in: Journal of cancer survivorship Vol. 17; no. 5; pp. 1405 - 1415
• Main Authors: de Rooij, Belle H., Ramsey, Imogen, Clouth, Felix J., Corsini, Nadia, Heyworth, Jane S., Lynch, Brigid M., Vallance, Jeff K., Boyle, Terry
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.10.2023; Springer Nature B.V
• Subjects: Amplitudes; Breast cancer; Circadian rhythm; Circadian rhythms; Clustering; Diagnosis; Fatigue; Health Informatics; Health Promotion and Disease Prevention; Insomnia; Latent class analysis; Medicine; Medicine & Public Health; Mental depression; Oncology; Primary Care Medicine; Public Health; Quality of Life Research; Regression analysis; Sleep; Sleep disorders; Stability analysis; Subgroups; Survival; Fatigue; Depression; Breast cancer; Circadian rhythm; Insomnia
• ISSN: 1932-2259; 1932-2267
• DOI: 10.1007/s11764-022-01189-w

Purpose Circadian rhythms control a wide range of physiological processes and may be associated with fatigue, depression, and sleep problems. We aimed to identify subgroups of breast cancer survivors based on symptoms of fatigue, insomnia, and depression; and assess whether circadian parameters (i.e., chronotype, amplitude, and stability) were associated with these subgroups over time. Methods Among breast cancer survivors, usual circadian parameters were assessed at 3–4 months after diagnosis (T0), and symptoms of fatigue, depression, and insomnia were assessed after 2–3 years (T1, N  = 265) and 6–8 years (T2, N  = 169). We applied latent class analysis to classify survivors in unobserved groups (“classes”) based on symptoms at T1. The impact of each of the circadian parameters on class allocation was assessed using multinomial logistic regression analysis, and changes in class allocation from T1 to T2 using latent transition models. Results We identified 3 latent classes of symptom burden: low (38%), moderate (41%), and high (21%). Survivors with a late chronotype (“evening types”) or low circadian amplitude (“languid types”) were more likely to have moderate or high symptom burden compared to “morning types” and “vigorous types,” respectively. The majority of survivors with moderate (59%) or high (64%) symptom burden at T1 had persistent symptom burden at T2. Implications for Cancer Survivors A late chronotype and lower circadian amplitude after breast cancer diagnosis were associated with greater symptoms of fatigue, depression, and insomnia at follow-up. These circadian parameters may potentially be novel targets in interventions aimed at alleviating symptom burden among breast cancer survivors.